The barroom doors swung open, and a tall, lanky cowboy wearing a white hat strode in, looking over his shoulder all the way to the bar.

Sam, the bartender, nodded and said, “Hi, A.C.A.” Those were the cowboy’s initials, but everyone else called him by his nickname, “Obamacare.”

“You look a little nervous,” said Sam. “Everything OK?”

A.C.A. took off his stetson and wiped his brow. “I’ve been chased by every gunslinger in Washington for the past seven years, but they haven’t got me yet,” he said. “Give me a beer.”

Sam poured the drink. “There’s a new guy in town with a wild, wavy head of hair who’s been looking for you. You’ll know him when you see him, ’cause he’s all hat and no cattle… and even the hat keeps falling off. Says his name is Donald the Kid.”

A.C.A. nodded, then winked. “Everywhere I go, they send someone else to kill me,” he said. When he turned back to the barroom, the guy Sam had just warned him about was staring straight at him.

“Finish your drink, Obamacare. It’ll be your last,” said Donald the Kid. He laughed and tried to twirl his gun but dropped it on the floor.

“I’ve heard that before,” replied A.C.A., reaching for his six-shooter. Suddenly a couple of guys grabbed him from behind and shoved him to the ground. It was an old-timer named Mitch and his sidekick John (who always stood behind Mitch’s right shoulder). Everyone knew him as “Doc.”

They held our hero down as Donald the Kid stood over him, strutting about and puffing out his chest. “Nice to meet you but you don’t look like you’re feeling too well” he said. “Hell, you’re laid out on the floor… must be in a death spiral. I’m going to kill you so fast it’ll make your head spin.”

Donald took a shot … and missed. He yelled at Mitch and Doc to hold his victim still — quick to blame others for his failings —  then emptied his gun. All five of the remaining bullets sped harmlessly past their target.

A.C.A. shook off his attackers, stood up and shoved Donald the Kid out of his way. “Get your weak stuff outta here,” he said, and moved past the shamed gunslinger before turning back and tipping his white cowboy hat.

“And when you get back home, tell them Obamacare is here to stay,” he said, then ambled back into the street.

Imagine how shocked Republicans were when the Affordable Care Act survived their attacks and remained the law of the land, after they had promised to repeal and replace “Obamacare” over and over for the past seven years. President Donald Trump, who had promised Americans he would provide better and cheaper healthcare, and that they would grow tired of winning, still couldn’t claim a single accomplishment six months into his term.

In a new national poll released last Friday by the nonpartisan Kaiser Family Foundation, nearly four out of every five Americans said they want Trump and Congressional Republicans to stop trying to kill Obamacare and instead work with Democrats to fix its problems. Those problems include premiums that are too high and insurance companies leaving the health marketplaces in several states.

The GOP has tried but failed to stop the ACA every step of the way since the bill was introduced in 2009, blaming Democrats for their inability to do so all along the way. Now they have control of the entire federal government, and are out of excuses. But they never bothered to come up with an improvement — just a House bill that would throw 24 million people off insurance and a terrible Senate bill that was haphazardly tossed together in secret by 13 rich old white guys, including “Mitch” McConnell and John “Doc” Barrasso.

Trump has threatened not to honor the fundamentals of the ACA. The resulting uncertainty has thrown the entire health care system into chaos. Insurers across the nation have had to raise their premium rates to account for the government potentially failing to keep up its end of the bargain. Of course ACA opponents have, from the outset suggested that “the feds” would ultimately fail to meet their obligations. Turns out they may have been right. In Wyoming the only ACA insurance provider, Blue Cross Blue Shield of Wyoming, recently announced its intention to raise rates an average of 48 percent for 2018. The rate request is being reviewed by the federal Centers for Medicare and Medicaid Services.

That’s one of the highest rate increases in the nation, but it should be kept in perspective. BCBS of Wyoming also reported its medical loss ratio last year was 102.1 percent. A number over 100 indicates that the insurance company is spending more on claims than it’s collecting in premiums. Obviously that type of loss is not sustainable very long.

Do any of the GOP proposals address skyrocketing costs of care? No. No they do not.

Things will likely continue to get worse. After his latest Senate loss on Obamacare, Trump tweeted, “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”

Trump can blame Obama or Hillary Clinton or other Democrats all he wants, and he will. But the KFF poll shows that Americans are on to him. The only way Obamacare will implode is if Republicans are allowed to keep sabotaging it. The only way they’ll ever end their war on the health law is if voters hold the GOP accountable for the disfunction they’ve created by trying to destroy it.

The president has threatened to withhold the funds now paid to insurers to subsidize low-income ACA enrollees. Congress could still take action this year to repeal the federal mandate to have health insurance. Failing that, the Trump administration could simply make the mandate impotent by refusing to enforce the penalty.

The individual mandate is one of the fundamental principles that makes the ACA work. By drawing younger, healthier Americans into insurance pools, companies are able to cover the health problems of chronically ill people. Removing the mandate would be like cutting off one of Obamacare’s legs, then accusing it of collapsing under its own weight which is precisely why every GOP plan has called for a mandate repeal.

Trump probably thinks he can convince voters he’s saving money by withholding the $7 billion cost-sharing reduction funds from insurers. He won’t, and here’s why:

Under the law ACA enrollees are guaranteed to pay no more than a certain percentage of their income on pre-subsidy insurance premiums. If rates are raised, the subsidies will be increased too. Because 89 percent of the 24,000 enrollees on Wyoming’s exchange program get subsidies, the vast majority will generally be protected from premium increases.

So who will bear the brunt of those much higher rates? The Kaiser Family Foundation says, “Ultimately, most of the burden of higher premiums on exchanges falls on taxpayers. Middle and upper-middle income people purchasing their own coverage off-exchange, however, are not protected by subsidies and will pay the full premium increase, switch to a lower level plan, or drop their coverage.”

Instead of saving taxpayers money, the KFF found that the federal government would end up paying 23 percent more than the potential savings from eliminating Obamacare’s cost-sharing subsidies. It works out to an estimated $2.3 billion more in 2018.

Talk about a lose-lose proposition: unsubsidized ACA enrollees making more than 400 percent of the federal poverty level will pay higher premiums, and Uncle Sam will also get hit with a much higher bill. Sounds like Trumpian economics at work!

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The president can say he and other Republicans won’t “own” Obamacare. He can even hold his breath until his face turns a different shade of orange. But it’s still a lie. They are responsible for not caring about what’s best for the public’s health care and instead trying to score cheap political points by sabotaging the system.

We all know the ACA would be better in Wyoming, and every other state, if it had been allowed to operate as planned. Americans need to take a good hard look at who stood in the way, and why.

Kerry Drake

Veteran Wyoming journalist Kerry Drake has covered Wyoming for more than four decades, previously as a reporter and editor for the Wyoming Tribune-Eagle and Casper Star-Tribune. He lives in Cheyenne and...

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  1. For seven years we heard “repeal and replace”. Seven years! If Republicans had been serious they would have had a truly gold standard of healthcare for all Americans ready to replace the ACA on day one of the new presidency. They weren’t serious as evidenced by the fact that the House voted 60 times to repeal the ACA but not replace it with any workable plan. Shame on them.